Rapid urease test for H. pylori diagnosis: pros and cons

Background: Metronidazole is one of the antimicrobial drugs that can be used in combination with other drugs for eradication of Helicobacter pylori (H. pylori).Unfortunately, metronidazole resistance in H. plori is an increasing health problem which may be attributed to inactivation of many genes as rdx A gene. Objective: To determine the frequency of rdx A deletion mutation in H. pylori detected in infected patients attending at the Gastroenterology Unit, Zagazig University Hospitals. Methodology: Two gastric biopsies were taken from each enrolled patient by endoscopy. H.pylori detection was done by rapid urease test and polymerase chain reaction (PCR) amplification of 16S rRNA gene. Deletion mutation in rdx A gene was detected by conventional PCR. Results: Out of 134 doubled gastric biopsies obtained from 134 patients, 52.2% were positive for H. pylori. Epigastric pain, vomiting and gastritis were significantly associated with detection of H. pylori infection (p˂ 0.05). Deletion mutation of rdx A gene was detected in 28.6% of H. pylori positive specimens obtained from infected patients. Conclusion: Deletion mutation of rdx A gene is a frequent determinant of rdx A inactivation conferring metronidazole resistance among H. pylori.

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Incidence of Gastric Metaplasia and Helicobacter pylori Infection in Duodenal Bulb – With Specific Reference to Patients With Duodenal Ulcers

Diagnostic and Therapeutic Endoscopy ◽

10.1155/dte.6.17 ◽

1999 ◽

Vol 6 (1) ◽

pp. 17-23 ◽

Cited By ~ 4

Author(s):

Minoru Kawaguchi ◽

Toshihiko Saito

Keyword(s):

Helicobacter Pylori ◽

Duodenal Bulb ◽

Mucosal Injury ◽

Transitional Zone ◽

Specific Reference ◽

Rapid Urease Test ◽

Duodenal Ulcers ◽

Gastric Metaplasia ◽

Urease Test ◽

H Pylori

We determined the incidence of gastric metaplasia in the duodenal bulb of duodenal ulcer patients and the Helicobacter pylori (H. pylori) infection rate at sites with gastric metaplasia. Biopsy of the duodenal bulb showed the presence of gastric metaplasia in 61 of 86 patients (71%) overall and in 18 of 47 patients (38.3%) who had gastrectomy at an early gastric cancer. The histological diagnosis of H. pylori infection showed good agreement (83.3%) with the result of the rapid urease test, indicating that H. pylori occurs in regions with gastric metaplasia. This finding suggests that H. pylori infects gastric metaplasia in the duodenal bulb, causing mucosal injury, which is then transformed into duodenal ulcers. The exact mechanism by which gastric metaplasia is caused is unknown, but it is believed to occur in the transitional zone in the duodenal mucosa.

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Standard Triple Therapy versus Sequential Therapy inHelicobacter pyloriEradication: A Double-Blind, Randomized, and Controlled Trial

Gastroenterology Research and Practice ◽

10.1155/2015/818043 ◽

2015 ◽

Vol 2015 ◽

pp. 1-5 ◽

Cited By ~ 3

Author(s):

Jaime Natan Eisig ◽

Tomás Navarro-Rodriguez ◽

Ana Cristina Sá Teixeira ◽

Fernando Marcuz Silva ◽

Rejane Mattar ◽

...

Keyword(s):

Triple Therapy ◽

Controlled Trial ◽

Sequential Therapy ◽

Rapid Urease Test ◽

Double Blind ◽

Intention To Treat ◽

Standard Triple Therapy ◽

Urease Test ◽

H Pylori ◽

Triple Treatment

Aim. To compare 10-day standard triple therapy versus sequential therapy as first-line treatment in patients infected withH. pylori.Methods. One hundredH. pyloripositive patients (diagnosed by rapid urease test and histology), with average age of 47.2, M/F = 28/72, were randomized to receive either standard triple treatment (TT) as follows: lansoprazole 30 mg, clarithromycin 500 mg, and amoxicillin 1 g, b.i.d. for ten days, or sequential treatment (ST) as follows: lansoprazole 30 mg, amoxicillin and placebo 1.0 g b.i.d for the first five days, followed by lansoprazole 30 mg, clarithromycin 500 mg, and tinidazole 500 mg b.i.d, for the remaining five days. Eradication rates were determined 60 days after treatment by urease, histology, or13C-urea breath test.Results. In intention to treat (ITT) analysis, the rate ofH. pylorieradication in the TT and ST groups was the same for both regimens as follows: 86% (43/50), 95% CI 93,3 to 73.4%. In Per protocol (PP) analysis, the rate ofH. pylorieradication in the TT and ST groups was 87.8% (43/49), 95% CI 94,5 to 75.3% and 89.6% (43/48), 95% CI 95,8 to 77.3%, respectively.Conclusions. In Brazil, standard triple therapy is as equally effective as sequential therapy in eradicatingHelicobacter pyloripatients. This study was registered under Clinical Trials with numberISRCTN62400496.

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GASTROESOPHAGEAL REFLUX DISEASE

The Professional Medical Journal ◽

10.29309/tpmj/2011.18.04.2677 ◽

2011 ◽

Vol 18 (04) ◽

pp. 693-696

Author(s):

ABDUL RAZZAQ WARRAICH ◽

DR. RAFFAD ◽

CHAUDHRY MUHAMMAD SIDDIQ ◽

Zaheer Iqbal ◽

Mohammad Saeed Khokhar

Keyword(s):

Gastroesophageal Reflux Disease ◽

Gastroesophageal Reflux ◽

Reflux Disease ◽

Rapid Urease Test ◽

Common Symptom ◽

Infection Frequency ◽

Urease Test ◽

H Pylori ◽

Disease Study ◽

Study Setting

Objective: To find the frequency of H pylori infection among the patients of gastroesophgeal reflex disease. Study design: Descriptive study. Setting: Department of Medicine, Unit-I, Services Hospital, Lahore. Subject & method: One hundred patients with gastroesophageal reflux disease (GERD) were included in this study. For detection and confirmation of helicobacter pylori, endoscopy with antral biopsy was done. Specimens were sent for histopathology, and rapid urease test was performed. Main outcome measures: Frequency of H pylori infection, frequency of regurgitation, dysphagia, nausea, vomiting and haemetemesis. Results: 100 patients who fulfilled the inclusion criteria were taken. There were 65 males and 35 females respectively. Their age ranged from 18 to 48 years. 39 (39%) patients were between 29-38 years while 23 (23%) were of 39-48 years. There were 38 (38%) patients between 18-28 years. The mean age of the patients was 31.79±7.56. 40 (40%) were found to be H. pylori positive on biopsy and rapid urease test, while 60 (60%) were H. pylori negative. The most common recorded symptom was chest pain/retrosternal burning (90%). Regurgitation (65%) and nausea (55%) were other common symptoms. Dysphagia and water-brash were present in 40% each. Vomiting (30%), abdominal pain (25%) and cough (20%) were the other symptoms. The least common symptom was haemetemesis (5%). Conclusions: A causal relationship between GERD and H. pylori infection could not be established. Therefore, routine H. pylori eradication in the treatment of patients with GERD is not recommended.

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Eradication of Helicobacter pylori in patients without gastric symptoms suffering from recurrent aphthous stomatitis: A pilot study

Vojnosanitetski pregled ◽

10.2298/vsp151014113l ◽

2017 ◽

Vol 74 (7) ◽

pp. 672-675 ◽

Cited By ~ 1

Author(s):

Marina Latkovic ◽

Lazar Ranin ◽

Nevenka Teodorovic ◽

Marko Andjelkovic

Keyword(s):

Eradication Therapy ◽

Recurrent Aphthous Stomatitis ◽

Aphthous Stomatitis ◽

Diffusion Method ◽

Gastric Disease ◽

Warning Sign ◽

Rapid Urease Test ◽

Sensitivity Testing ◽

Urease Test ◽

H Pylori

Background/Aim. Helicobacter (H.) pylori is a widespread bacterium and its involvement in pathogenesis of gastric diseases is well-known. However, H. pylori role in etiology of other histologically similar conditions, especially recurrent aphthous stomatitis (RAS) is still controversial. Research regarding H. pylori and its association with RAS, as well as the treatment options were always conducted on patients with diagnosed gastric problems. The aim of this study was to determine whether H. pylori is present in the oral cavity of patients suffering from RAS but without any symptoms or medical history of gastric disease. Methods. A total of 15 patients with RAS participated in the study. None of the participants suffered from any gastrointestinal disorders. Two dental plaque samples from each participant were collected. The first was analyzed using rapid urease test and the second one was put in transport medium and sent for cultivation. The sensitivity of H. pylori to antibiotics was established using disk diffusion method of sensitivity testing for every patient individually and adequate therapy was prescribed. Results. Before the treatment the mean annual recurrence rate of RAS was 8.1 ? 2.1, with the average number of lesions being 3.9 ? 1.9. During the 12-month observation period after the eradication therapy, none of the patients reported recurrence of aphthous lesions. The treatment was successful in all cases. Conclusion. This study shows that RAS can be effectively treated by successful eradication of oral H. pylori, and that RAS could be possibly considered as an early warning sign of potential gastric infection by H. pilory.

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Can probiotics improve efficiency and safety profile of triple Helicobacter pylori eradication therapy? A prospective randomized study

Vojnosanitetski pregled ◽

10.2298/vsp150415127g ◽

2016 ◽

Vol 73 (11) ◽

pp. 1044-1049 ◽

Cited By ~ 3

Author(s):

Sasa Grgov ◽

Tomislav Tasic ◽

Biljana Radovanovic-Dinic ◽

Daniela Benedeto-Stojanov

Keyword(s):

Helicobacter Pylori ◽

Randomized Study ◽

Eradication Therapy ◽

Saccharomyces Boulardii ◽

Rapid Urease Test ◽

Group I ◽

Urease Test ◽

Probiotic Strains ◽

The Difference ◽

H Pylori

Background/Aim. Some studies suggest the benefit of applying different probiotic strains in combination with antibiotics in the eradication of Helicobacter pylori (H. pylori) infection. The aim of this study was to evaluate the effect of co-administration of multiple probiotic strains with triple H. pylori eradication therapy. Methods. This prospective study included 167 patients with dyspeptic symptoms and chronic gastritis who were diagnosed with H. pylori infection and randomized into two groups. The group I of 77 patients underwent triple eradication therapy, for 7 days, with lansoprazole, 2 ? 30 mg half an hour before the meal, amoxicillin 2 ? 1.000 mg per 12 hours and clarithromycin 2 ? 500 mg per 12 hours. After the 7th day of the therapy, lansoprazole continued at a dose of 30 mg for half an hour before breakfast for 4 weeks. The group II of 90 patients received the same treatment as the patients of the group I, with the addition of the probiotic cultures in the form of a capsule comprising Lactobacillus Rosell-52, Lactobacillus Rosell-11, Bifidobacterium Rosell-1755 and Saccharomyces boulardii, since the beginning of eradication for 4 weeks. Eradication of H. pylori infection control was performed 8 weeks after the therapy by rapid urease test and histopathologic evaluation of endoscopic biopsies or by stool antigen test for H. pylori. Results. Eradication of H. pylori infection was achieved in 93.3% of the patients who received probiotics with eradication therapy and in 81.8% of patients who were only on eradication therapy without probiotics. The difference in eradication success was statistically significant, (p < 0.05). The incidence of adverse effects of eradication therapy was higher in the group of patients who were not on probiotic (28.6%) than in the group that received probiotic (17.7%), but the difference was not statistically significant. Conclusion. Multiple probiotic strains addition to triple eradication therapy of H. pylori achieves a significantly better eradication success, with fewer side effects of antibiotics.

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Antibiotic resistance of Helicobacter pylori in the European part of the Russian Federation: first results

Terapevticheskii arkhiv ◽

10.26442/00403660.2020.08.000761 ◽

2020 ◽

Vol 92 (8) ◽

pp. 24-28

Author(s):

I. V. Maev ◽

D. N. Andreev ◽

V. M. Govorun ◽

E. N. Ilina ◽

Yu. A. Kucheryavyy ◽

...

Keyword(s):

Helicobacter Pylori ◽

Antibiotic Resistance ◽

Russian Federation ◽

European Part ◽

Diffusion Method ◽

Rapid Urease Test ◽

Urease Test ◽

First Results ◽

The Russian Federation ◽

H Pylori

Aim. Determine the primary antibiotic resistance of Helicobacter pylori (H. pylori) strains isolated from patients living in the European part of the Russian Federation. Materials and methods. As part of a clinical laboratory study, from 2015 to 2018, 27 gastrobiopsy samples obtained from H. pylori-infected patients were analyzed. H. pylori infection was verified using a rapid urease test or a 13C-urea breath test. The values of the minimum inhibitory concentration (MIC) of antibiotics were determined by the diffusion method using E-test strips (BioMerieux, France) according to the recommendations of the manufacturer. The sensitivity of the isolates was determined for 6 antibacterial drugs (amoxicillin, clarithromycin, metronidazole, levofloxacin, tetracycline, rifampicin). Results. According to the data obtained, resistance to amoxicillin was 0%, clarithromycin 11.1%, metronidazole 59.3%, levofloxacin 3.7%, tetracycline 0%, and rifampicin 14.8%. Dual resistance to clarithromycin and metronidazole was recorded in two isolates (7.4%). Conclusion. Thus, the first results of the evaluation of H. pylori antibiotic resistance in the European part of the Russian Federation indicate a low resistance of the microorganism to clarithromycin and quite high to metronidazole.

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Association between gallbladder diseases and Helicobacter pylori infection

AL-Kindy College Medical Journal ◽

10.47723/kcmj.v16i2.263 ◽

2020 ◽

Vol 16 (2) ◽

pp. 30-34

Author(s):

Ali Hamid Abd-Almahdi ◽

Zuhair B. Kamal

Keyword(s):

Helicobacter Pylori ◽

Urban Areas ◽

Weight Status ◽

Gallbladder Disease ◽

Case Series ◽

Rapid Urease Test ◽

Gallbladder Diseases ◽

Case Series Study ◽

Urease Test ◽

H Pylori

Background: Helicobacter pylorus is one of the most harmful human pathogens & carcinogen. Of the world's population, more than 50% has H. pylori in their upper gastrointestinal tracts. It has been linked to a variety of extra gastric disorders. In correlation to hepatobiliary diseases; recently, the bacterium has been implicated as a risk factor for various diseases ranging from chronic cholecystitis and primary biliary sclerosing cholangitis to gall bladder cancer and primary hepatic carcinomas. However, the association between Helicobacter pylori (H. pylori) and gallbladder diseases is still vague and is controversial. Aim of study: To elucidate the association of H pylori and gallbladder diseases (calculus, acalculous, polyp), the feasibility of using rapid urease test in post-operative diagnosis, and many factors related bacterium. Subjects & methods: This case series study was conducted in Al-Kindy Teaching hospital - surgical unit during a period extended for 2 years from September 2016 to September 2018, where patients suffered from signs and symptoms of gallbladder disease were interviewed using a predesigned questionnaire including age, gender, occupation, residency and whether the drinking water was safe (purified) or not. Physical examination was done including weight status, BMI was calculated (BMI=wt. (kg)/ height (M) [2]. Provisional diagnosis of gallbladder disease was confirmed by examination, necessary laboratory investigations (Hematology, Biochemistry, and radiology). Cholecystectomy was done by using Laparoscopic cholecystectomy or open surgery. The presence of H.pylori in the mucosa of excised gallbladder was studied by using: 1) Rapid urease kit (HNAN C., LTD) 2) Histopathology & chemical analysis of associated gallstone Results: Seventy-eight patients undergoing cholecystectomy for symptomatic gallbladder disease, the gallbladder mucosa of 30 patients were tested positive for H. pylori with any one of the tests used in this study. The rapid urease test was sensitive 57.1% and specific 58.3 % of the cholecystectomies performed in our study. The mean age of studied patients was (34 ± 4 years). Females constitute 73.1% (57 out of the total 78 of patients). Of the studied cases; 26 patients (33.3%) were obese. Employee patients constitute 43 (55.1%) of patients, and 53 patients (67.9%) lived in urban areas. Purified water consumed by 61 (78.2%) of the studied population. Gallstones were detected in 56 (71.8%) of studied cases, acalculus chronically inflamed gallbladder was found in 20 (25.64%), and 2 cases (2.56%). were found to have gallbladder polyp. pylori infection was diagnosed in 30 (38.5%) of total cases (of the 56 calculus confirmed cases 48.2% were H.pylori positive, and of the 22 acalculus cases 13.6% H.pylori positive). Conclusion: Significant association is found between chronic calculus cholecystitis and H.pylori infection. While no significant association was found in correlation with acalculus cholecystitis and other gallbladder pathology. In regard to feasibility of using urease kit test, it is found that this test is sensitive 57.1%, and specific 58.3%, as such it is less accurate than histopathology study. Significant correlation was found between age, gender, weight status, and non-purified water source with H.pylori infection..

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Antibiotic Resistance and Genotypes of Helicobacter pylori Strains in Patients with Gastroduodenal Disease in Southeast Poland

Journal of Clinical Medicine ◽

10.3390/jcm8071071 ◽

2019 ◽

Vol 8 (7) ◽

pp. 1071 ◽

Cited By ~ 3

Author(s):

Izabela Korona-Glowniak ◽

Halina Cichoz-Lach ◽

Radoslaw Siwiec ◽

Sylwia Andrzejczuk ◽

Andrzej Glowniak ◽

...

Keyword(s):

Genetic Diversity ◽

Helicobacter Pylori ◽

Test Method ◽

Rapid Urease Test ◽

Microbial Culture ◽

Virulence Markers ◽

Gastroduodenal Disease ◽

Urease Test ◽

Gastric Biopsies ◽

H Pylori

The aim of this study was to investigate genetic diversity of Helicobacter pylori virulence markers to predict clinical outcome as well as to determine an antibiotic susceptibility of H. pylori strains in Poland. Gastric biopsies from 132 patients with gastrointestinal disorders were tested for presence of H. pylori with the use of rapid urease test, microbial culture, and polymerase chain reaction (PCR) detection. The genetic diversity of 62 H. pylori positive samples was evaluated by detection of cagA and PCR-typing of vacA and iceA virulence-associated genes. Most common H. pylori genotypes were cagA(+)vacAs1m2 (27.4%) and cagA(−)vacAs2m2 (24.2%). In logistic regression analysis, we recognized the subsequent significant associations: gastritis with ureC, i.e., H. pylori infection (p = 0.006), BMI index (p = 0.032); and negatively with iceA1 (p = 0.049) and peptic ulcer with cagA (p = 0.018). Thirty-five H. pylori strains were cultured and tested by E-test method showing that 49% of strains were resistant to at least one of the tested antibiotics. This is the first study that reports the high incidence and diversity of allelic combination of virulence genes in gastroduodenitis patients in Poland. Genotyping of H. pylori strains confirmed the involvement of cagA gene and vacAs1m1 genotype in development and severity of gastric disorder.

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Good diagnostic accuracy of a chemiluminescent immunoassay in stool samples for diagnosis of Helicobacter pylori infection in patients with dyspepsia

Journal of Investigative Medicine ◽

10.1136/jim-2015-000004 ◽

2016 ◽

Vol 64 (2) ◽

pp. 388-391 ◽

Cited By ~ 6

Author(s):

María José Ramírez-Lázaro ◽

Josep Lite ◽

Sergio Lario ◽

Pepa Pérez-Jové ◽

Antònia Montserrat ◽

...

Keyword(s):

Helicobacter Pylori ◽

Gold Standard ◽

Rapid Urease Test ◽

Diagnostic Reliability ◽

Predictive Values ◽

Urease Test ◽

Stool Samples ◽

H Pylori ◽

Good Diagnostic Accuracy ◽

Sensitivity Specificity

Laboratory-based chemiluminescence immunoassays (CLIA) are widely used in clinical laboratories. Some years ago, a CLIA test was developed for the detection of Helicobacter pylori in stool samples, known as LIAISON H. pylori SA, but little information on its use has been reported. To evaluate the accuracy of the LIAISON H. pylori SA assay for diagnosing H. pylori infection prior to eradication treatment. Diagnostic reliability was evaluated in 252 untreated consecutive patients with dyspepsia. The gold standard for diagnosing H. pylori infection was defined as the concordance of the rapid urease test (RUT), histopathology and urea breath test (UBT). The CLIA assay was performed according to the manufacturer's instructions. Sensitivity, specificity, positive and negative predictive values, and 95% CIs were calculated. According to the gold standard selected, 121 patients were positive for H. pylori infection and 131 negative. LIAISON H. pylori SA had a sensitivity of 90.1% and a specificity of 92.4%, with positive and negative predictive values of 91.6% and 90.1%, respectively. The accuracy of the LIAISON H. pylori SA chemiluminescent diagnostic assay seems comparable to that of ELISA or the best-performing LFIAs. Its sensitivity and specificity, however, seem slightly lower than those of histology, RUT or UBT. The advantages of the assay are that it is cheap, automated, and minimally labor-intensive.

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